What you need to know about diastasis recti

Have you heard of diastasis recti, also referred as 'split' or ‘separated’ tummy muscles, or ‘tummy gap’? Or would you go “split tummy what??" like so many new mums I work with? 

Diastasis Recti is a very common in late pregnancy and postpartum. And yet, a great majority of women have never or only vaguely heard of it, and therefore are completely unaware they may actually have some degree of diastasis, which may be affecting the integrity of their core in the immediate postnatal period, and often further down the line. This is not helped by the fact is diastasis is extremely rarely checked as part of the standard 6-week postnatal check.

So whether you’re recovering from birth, further into your postnatal year(s) or are still pregnant, here are 5 things that you need to know about diastasis.

What is Diastasis Recti, exactly?

Diastasis recti is the name given to the stretching, thinning and slackening of the connective tissue that runs along your midline above and below your belly button, in the middle of the rectus abdominal muscles (your ‘6 pack’ muscles) . This tissue - called the linea alba - links up the left and right bands of the rectus, and reaches up to the chest bone and to the pelvis, intertwining with the pelvic floor tissues.

During pregnancy, this connective tissue naturally stretches to accommodate your growing baby, losing tension and so the two bands of the 6-pack muscles are ‘pulled’ apart (although they only very rarely actually split), creating a ‘gap’.

This gap can be located above the belly button, below the belly button, or along the whole midline, and can be more or less pronounced. You can see a mild ‘gap’ in the picture heading this blog post, althuogh you can also notice some ‘doming’ or ‘coning’ along the midline (see below).

However, although diastasis is often talked about in terms of ‘gap’, what really matters here is the functionality of the midline/connective tissue, its springiness/ability to respond and tense up when needed.

How likely am I to have or develop diastasis?

It is thought that at least 60%, if not 99% (depending on studies) of women will develop some level of diastasis in late pregnancy. This is a completely natural response of the body to accommodate a growing baby, that we shouldn’t look to ‘fight’ as such but can rather look not to aggravate unnecessarily. See below for some advice on how best to support your core integrity during pregnancy.

After birth, most women will therefore have some degree of diastasis. A lower diastasis (from the belly button down to the pubic bone) is also extremely common if you’re had a caesarean birth due to the way the operation is done to birth your baby.

As the body works to re-close and re-knit itself, abdominal ‘separation’ usually heals gradually and naturally in the first 8 to 12 weeks after birth (the ‘Golden Window’ of postnatal recovery). However, for some women, this doesn’t happen, or not completely, and the ‘gap’ & lack of tension of the midline connective tissues remains. This is more common in second/third pregnancies, where the tissues would have been stretched by a first pregnancy already, if there was an unhealed diastasis before, but also depends on our individual tissue quality

Does it really matter?

Because your rectus muscles and the connective tissues around it are part of your core, an unhealed diastasis means the core has lost some of its integrity, which may be a contributing factor in core-related issues (for example, lower back pain, pelvic pain/instability and/or pelvic floor dysfunction). Postnatally, this lack of containment for the abdominal organs can also contribute to digestive issues and discomforts, including bloating/excess gas, constipation or IBS.

On an aesthetic level, a diastasis can also be the reason why your belly still looks like your 4 or 5 month-pregnant belly long after birth (so often called the ‘mum tum’ - an expression I despise!), even when your body might have already shed the extra water and weight gained during pregnancy.

However, it is always important to look at the body as a whole, and not pinpoint the diastasis as the sole or obvious ‘culprit’ of such discomforts or dysfunctions!

Even if there is no dysfunction or discomforts, it is worth knowing that an ‘unhealed’ diastasis is likely to worsen with subsequent pregnancies, which might increase the likelihood of symptoms before and after birth, and the effort required to heal it in the postnatal recovery period and beyond. So it’s important to take the time to heal well between pregnancies.

How can I check if I have diastasis?

Frustratingly, diastasis is not routinely checked as part of the postpartum 6/8-week check offered by GPs, which is one of the reasons why so many women are unaware they may have some degree of it.

The quick video below illustrates how you can self-check at home the width of your abdominal gap, and the tension in your linea alba once you’ve had your baby.

A diastasis is usually measured by how many finger-widths can fit in the ‘gap’ between the two bands of the rectus abdominal muscle, as well as how deep that gap is, i.e. how much tension there is or can be mustered in the connective tissue of the midline. Although there is some level of debate about the exact measurement, a gap of about 1 finger’s width (or 25mm) is usually considered normal, and 2 fingers’ width considered a mild degree of diastasis, but again, it’s mostly the responsiveness and springiness of the connective tissue you want to focus on.

If you discover a fairly large gap, or are also experiencing symptoms such as pelvic floor issues, lower back pain or pelvic instability, I always recommend seeing a women’s health physiotherapist, who will assess more accurately and holistically the degree of separation and all contributing factors to your symptoms.

If you are pregnant, you cannot check in this way, but you might notice a ‘gap’ along your midline simply by looking into the mirror, or you can ask your midwife to check for you. You might also notice some doming/coning (your belly going a little bit pointy or bulging out in the midline) as you lie down for example.

I have diastasis - what can I do?

First of all, whatever stage you’re at, don’t worry or panic! The most important thing for you to know is that it is never too late to heal and work with a diastasis, even if you’re years past the postpartum period, and to understand what a healed /functional diastasis means or looks like (it is not necessarily that the ‘gap is closed’!)

If you are pregnant, especially towards late pregnancy, we want to think about managing the diastasis rather than repairing it as such, as this is your body’s natural response to making more space for your baby. Rather, you want to focus on maintaining as much core integrity and elasticity in the connective tissues as possible, and avoid putting the tissues under unnecessary strain.

If you are in the early postnatal period (first 8-12 weeks after birth), although your body is actively trying to close and heal after birth, research shows that a diastasis that hasn’t healed at 3 months postpartum is most likely to remain the same at 12 months postpartum if left unaddressed. So it’s really worth supporting your body’s natural healing process as early as possible after birth to ensure your diastasis heals. You can check on your progress by performing the self-check every couple of weeks,

So where do you start?

• Simple but highly important adjustments to your posture (in various positions) and breathing pattern are the foundations of core integrity, postnatal recovery and of healing a diastasis.

• Then, specific movements and exercises, including mindful pelvic floor exercises, reducing ribcage flaring, lengthening and gentle twisting of the midline and core structures, gradually adding more resistance and load, can help you improve or completely restore a diastasis to functional levels

• In all these practices, approaching things mindfully and intelligently rather than with force is a key element of a good understanding of your diastasis and long-term recovery.

• Until your diastasis is resolved, it is also very important to know how to approach and adapt certain movements that can otherwise aggravate it or get in the way of the healing process: this includes ‘classic abs crunches’, planks, some deep twisting movements, heavy lifting, and unsupported transitions from sitting to lying down and from lying to sitting.

In this video, I walk you through 5 prenatal and postnatal practices to support your core integrity and start repairing a diastasis.

Attending a regular pregnancy yoga or postnatal yoga class is the best way to effectively support your body’s changes in pregnancy and recovery after birth.

If you need more targeted support, 1-1 postnatal recovery yoga sessions will give you personalised guidance, with feedback on your posture and breathing, and progressive exercises in a safe, effective way, to address you diastasis, and your overall recovery.